How do you decide between observation and surgical repair for an asymptomatic ureteropelvic junction obstruction with moderate to severe hydronephrosis and normal creatinine found incidentally in an adult?

Among adults with this situation, I make a decision on several factors:

a. Are they at all symptomatic? If they note they are without symptoms, then I have one more question and that is if they had any pain after their lasix washout renal nuclear scan. If not, then that is one reason to leave them a...

If the patient is entirely asymptomatic, has moderate hydronephrosis and normal renal function, I generally use a Mag3 renal scan with lasix washout as the tie breaker. If the study shows asymmetry in renal function contribution, suggesting chronic slow deterioration of the affected renal unit, then...

So this is a complex question. There are many factors that go into deciding how to manage this. While I heard that there is moderate to severe hydronephrosis and the overall renal function is normal, other significant considerations are: what does the contralateral kidney look like? Is it a nice, ro...